Josie Bellings is returning patient who had been diagnosed and treated for anxiety six weeks ago and has returned for a follow-up visit. She states that her symptoms improve by up to 80% when she is on medication bus she still struggles with controlling her anxiety especially when she is at work. She reports experiencing an anxiety attack at work recently during code-blue. She states that she is tolerating the drug well but complains that the medication has been making her mouth dry and has decreased her sex drive, placing her strain in her relationship.
Some of the medications that Josie could take to “as needed” to manage her anxiety include Zoloft (Sertraline), Ativan (Lorazepam), Xanax (Alprazolam) or Atarax (Hydroxyzine). Zoloft is one of the commonly prescribed anxiety medication that can be taken as needed. Its pros include having minimal side effects, causing less drowsiness when compared to other anxiety medication, and being suitable for different vulnerable groups like pregnant mothers, which could be an added advantage because Josie is sexually active and most people do not usually find out about their pregnancies until after the first few weeks. The main disadvantage linked to Zoloft is that it can take up to 12 weeks before being effective. Advantages of Xanax include being effective in reducing anxiety within a few hours and offering patients fast relief. Its cons include risk of addiction, withdrawal symptoms after using it for a long time, mood changes, and side effects like decreased libido (Patel, Feucht and Brown). The side effects of Xanax might further interfere with Josie’s relationship with Robs.
The other drugs that Josie could consider would be Ativan and Atarax. Some of the benefits of Ativan include short-time relief, being helpful for specific situations like Josie’s code blue case, and improved sex drive. Its disadvantages include risk of addiction when used for a prolonged period, confusion, fatigue, and disorientation. These effects are linked to long-term use of Ativan (Balon, Rafanelli and Sonino; Pomara, Lee and Bruno). Atarax is an antihistamine whose benefits include providing relief within 30 minutes and lacking addictive effects. Its disadvantages include having sedative effects on some people and not being effective in some instances.
Before prescribing the medication, I would conduct an assessment to determine Josie’s overall health status. Some of the questions that I would ask Josie include whether she had noticed any other side effects of the initial treatment and how frequently she used the drugs within the six weeks. These would assist me to determine her risk of addiction to drugs like Ativan and Xanax as these drugs are linked to high risks of addiction (Maisto, Galizio and Connors 345; Ait-Daoud, Hamby and Sharma). I would also conduct a chemistry profile and a urine drug screen to assess for toxicities of the previous drug.
The pharmacological treatment of choice would be Atarax (Hydroxyzine). The selection of Atarax would be because it takes a short time to become effective and it does not have addictive effects like Xanax and Ativan. Atarax is also an FDA-approved drug for treating anxiety. Comparison of Atarax and placebo has revealed that Atarax has anxiolytic effects that assist patients with generalized anxiety to recover within a few weeks or after using a total dose of 50g. The starting dose will be 50mg taken as needed with the limitation of 100 mg per day. The drug works by competing with histamine for binding spots at the H1-receptor sites and suppressing the subcortical regions of the brain. This drug interacts with amiodarone, citalopram fluoxetine, clozapine, among other drugs. The patient will be advised to avoid using other drugs when using Atarax to reduce the risks of accidental interactions (Dooley 93). The recommendation and patient education will reduce risks of overreliance to the drug.
In terms of community support and therapy, I would request Josie to attend a social-support group counselling session that offers self-help for people dealing with anxiety. I would also recommend therapy to help Josie understand the cause of her anxiety and help her resolve it completely, thereby eliminating her need to rely on medication in future. Cognitive-behavioral therapies have been proven to be effective in treating anxiety among some patients (Bandelow). The therapy and social group will help Josie find alternative non-pharmacological ways of dealing with her anxiety.
In the case of Josie, effective management of her anxiety entails finding a drug that does not have extreme side effects, which can be used as needed, and one that does not have addictive effects. The selection of Atarax meets her needs as it provides relief within a short time. Atarax will assist her to manage her anxiety before she finds an alternative non-pharmacological option. Cognitive-behavioral therapy and the social-group meetings will help her identify the cause of her anxiety and manage it effectively.
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Balon, R., C. Rafanelli and N. Sonino. “Benzodiazepines: A Valuable Tool in the Management of Cardiovascular Conditions.” Psychotherapy and Psychosomatics (2018): 87: 327-330. https://www.karger.com/Article/FullText/493015.
Bandelow, Borwin. “Treatment of anxiety disorders.” Dialogues in Clinical Neuroscience (2017): 19(2), 93-107. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5573566/.
Dooley, Thomas P. “Treating Anxiety with either Beta Blockers or Antiemetic Antimuscarinic Drugs: A Review.” Mental Health in Family Medicine (2015): 11: 89-99. http://www.mhfmjournal.com/old/open-access/treating-anxiety-with-either-beta-blockers-or-antiemetic-antimuscarinic-drugs-a-review.pdf.
Maisto, Stephen A., Mark Galizio and Gerald J. Connors. Drug Use and Abuse. Cengage Learning, 2018.
Patel, Dilip R., et al. “Pharmacological treatment of anxiety disorders in children and adolescents: a review for practitioners.” Translational Pediatrics (2018): 7(1), 23-35. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5803020/.
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